A 7-Year Study of the Durability of Improvements in Pain, Physical Function, and Work Productivity After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Abstract

Importance: Bariatric surgical procedures are associated with clinically important improvements (CIIs) in pain and physical function. However, there are declines in initial improvement by the third postoperative year, and the long-term durability of improvements are not well-described.

Objective: To evaluate the durability of improvements in pain and physical function through 7 years after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

Design, setting, and participants: This study is part of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a cohort study at 10 US hospitals. Adults with severe obesity (ie, body mass index of 35 or greater) undergoing bariatric surgery were assessed preoperatively (2006-2009) and followed up annually for as long as 7 years or until 2015. Of 1829 participants who underwent RYGB or SG in LABS-2, 338 were excluded from this study because they had a follow-up period of less than 5 years. Analysis of participants who underwent RYGB or SG and completed research assessments preoperatively and postoperatively for 5 to 7 years was conducted from March to April 2022.

Main outcomes and measures: Preoperative-to-postoperative CIIs in pain and physical function scores from the 36-Item Short Form Health Survey and the Western Ontario McMaster Osteoarthritis Index, and 400-meter walk time, using previously established thresholds; and remission of mobility deficit, ie, inability to walk 400 meters in 7 minutes or less.

Results: A total of 1491 individuals were included, with 1194 (80%) women; 59 (4%) Hispanic, 164 (11%) non-Hispanic Black, and 1205 (82%) non-Hispanic White individuals; a preoperative median (IQR) age of 47 (38-55) years; and a preoperative median (IQR) body mass index of 47 (42-52). Between 3 and 7 years after surgery, the percentage of participants with preoperative-to-postoperative CIIs in bodily pain decreased from 50% (95% CI, 48%-53%) to 43% (95% CI, 40%-46%), in physical function from 75% (95% CI, 73%-77%) to 64% (95% CI, 61%-68%), and in 400-meter walk time from 61% (95% CI, 56%-65%) to 50% (95% CI, 45%-55%). Among participants with a preoperative mobility deficit, remission decreased from 50% (95% CI, 42%-57%) to 41% (95% CI, 32%-49%), and among participants with severe knee or hip pain or disability, the percentage with CIIs in knee and hip pain and function decreased (eg, hip pain: from 77% [95% CI, 72%-82%] to 65% [95% CI, 58%-72%]; knee function: from 77% [95% CI, 73%-82%] to 72% [95% CI, 67%-77%]).

Conclusions and relevance: In this cohort study, despite decreases in preoperative-to-postoperative improvements across follow-up, CIIs in perceived bodily and joint-specific pain and in self-reported and objectively measured physical function ranged from 41% to 72%, depending on the measure and subgroup, 7 years after surgery, suggesting that RYGB and SG are commonly associated with long-term CIIs in pain and physical function.

Figure.. Percentage of Adults with Clinical Important Improvements in Pain and Physical Function Measures by Year Since Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG)^a

All models were adjusted for site and age. Observed and modeled data are reported in eTables 5 and 6 in the Supplement, respectively. SF-36 indicates Medical Outcomes Study 36-Item Short-Form Health Survey; WOMAC, Western Ontario and McMaster Universities Osteoarthritis. ^aImprovements in bodily pain and physical function were evaluated among the entire sample; 400-meter walk time improvement was evaluated among participants who completed the walk preoperatively and postoperatively; improvements in knee pain and function were evaluated among those with symptoms indicative of osteoarthritis in the knee; improvement in hip pain and function was evaluated among those with preoperative symptoms indicative of osteoarthritis in the hip; and remission of mobility deficit was evaluated among those with a preoperative mobility deficit. ^bImprovement defined as an increase of at least 5 points on the norm-based scores. ^cImprovement defined as a decrease in completion time of at least 24 seconds or completed walk in 7 or fewer minutes. ^dImprovement defined as a decrease of at least 9.7 pain points or 9.3 function points. Overall, 12 of 459 participants with preoperative symptoms of osteoarthritis in the knee and 17 of 347 participants with preoperative symptoms of osteoarthritis in the hip were excluded from analysis of change in pain because their preoperative pain score was less than 9.7 points; 5 of 459 participants with preoperative symptoms of osteoarthritis in the knee and 7 of 347 patients with preoperative symptoms of osteoarthritis in the hip were excluded from analysis of change in function because their preoperative function score was below 9.3 points.